Citation

Shafi S, Parks J, Ahn C, Gentilello LM, Nathens AB. J. Trauma 2010; 69(1): 70-77.

Affiliation

Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas; Johns Hopkins Health System, Baltimore, Maryland; Department of Clinical Sciences, University of Texas Southwestern Medical School, Dallas, Texas; Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

Copyright

(Copyright © 2010, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0b013e3181e28168

PMID

20622580

Abstract

INTRODUCTION:: The Trauma Quality Improvement Project has demonstrated significant variations in risk-adjusted mortality rates across the designated trauma centers. It is not known whether the outcome differences are related to provider-level clinical decision making. We hypothesized that centers with good outcomes undertake critical operative interventions aggressively, thereby avoiding complications and deaths. METHODS:: The previously validated Trauma Quality Improvement Project risk-adjustment algorithm was used to measure observed-to-expected mortality rates (O/E with 90% confidence intervals CI) for 152 Level I and II trauma centers participating in the National Trauma Data Bank (version 7.0). Adult patients (>/=16 years) with at least one severe injury (Abbreviated Injury Scale score >/=3) were included (N = 135,654). Operative intervention rates for solid organ injuries (spleen, liver, and kidney) were compared between the centers classified as high mortality (O/E with CI > 1, n = 35 centers) versus low mortality (O/E with CI < 1, n = 37 centers) using nonparametric tests. RESULTS:: Low- and high-mortality trauma centers were similar in designation level, hospital and intensive care unit beds, teaching status, and number of trauma, orthopedic, and neurosurgeons. Despite a similar incidence and severity of solid organ injuries, low-mortality centers were less likely to undertake operative interventions. CONCLUSION:: Trauma centers with higher risk-adjusted mortality rates are more likely to undertake operative interventions for solid organ injuries. Hence, there is a need to focus quality improvement efforts on medical decision-making and perioperative processes of care.

Language: en